VASCULAR thrombosis is a significant concern in liver transplantation, particularly given the increasing prevalence of diabetes and obesity among donors and recipients. Studies indicate that approximately 15.5% of liver transplant recipients develop deep vein thrombosis (DVT), with potential complications such as pulmonary embolism (PE). Additionally, hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) occur in approximately 2% and 3% of cases, respectively, following deceased donor transplants, with even higher rates in living donor or split liver transplants. These complications can severely impact graft survival, morbidity, and mortality, posing challenges for post-transplant management.
While thromboprophylaxis is widely used to prevent DVT in major surgeries, its effectiveness in liver transplant patients remains uncertain. Current evidence suggests that routine chemical prophylaxis may not significantly reduce the incidence of DVT or PVT and may instead increase the risk of post-transplant haemorrhagic complications. As a result, no standardised protocols exist for chemical thromboprophylaxis in liver transplantation, highlighting the need for further multicentre, prospective randomised controlled trials (RCTs).
Enoxaparin, a low-molecular-weight heparin, is frequently used for venous thromboembolism (VTE) prevention in abdominal and orthopaedic surgeries. However, its role in liver transplantation is less clear. A recent prospective RCT evaluating enoxaparin’s impact on postoperative thrombosis and bleeding events found no significant reduction in DVT or PVT incidence. Instead, an increased risk of major bleeding was observed, raising concerns about its routine use in this patient population.
These findings challenge existing practices in some institutions that administer prophylactic anticoagulation after liver transplantation. While retrospective studies offer conflicting results, expert consensus remains divided. Notably, while postoperative anticoagulation is recommended for high-risk patients in some guidelines, its overall benefit remains unproven. Given that microsurgical advances have already reduced the incidence of HAT and PVT, alternative therapies such as aspirin or statins may warrant further investigation for their role in reducing vascular complications.
Further research is necessary to refine thromboprophylaxis strategies in liver transplantation. Future studies should assess anticoagulation efficacy across different transplant types, including living-donor and split liver transplantation, to ensure optimal patient outcomes while minimising associated risks.
Katie Wright, EMJ
Reference
Xie K et al. Comparing the efficacy and safety of thromboprophylaxis with enoxaparin versus normal saline after liver transplantation: randomized clinical trial. Br J Surg. 2025;112(2):znae325.
